Going Sleepless to War

War is hell, said General William Tecumseh Sherman, whose 1864 march to the sea changed the course of American and military history. And the practice of war, even in “peacetime” can be hell on the human body. That is the lesson of a panel at this year’s national sleep meetings in Seattle, entitled “Wounded in Action – What Sleep Science Can Learn From Sleep and Sleep Disorders of US Military Service Members.”

Among basic needs, sleep is on par with air, water and food. Totally sleep deprive an animal and it dies. Get an animal to sleep less than its usual allotment and you watch its bones erode, muscles weaken, cognition deteriorate and metabolism go haywire. As Dr. Carol Everson demonstrated at another panel at the meetings, the really horrible fact is that these debilities continue long after you stop partial sleep deprivation.

Chronic sleep deprivation is the lot of today’s American military.

Consider these facts: A. Most military personnel – 60-70% in several studies – sleep on average 6 hours or less each day. Lots get by on less than five. 2. Many military personnel perform shifts on what Dr. Nita Shattuck of the Monterey Postgraduate Military School described as “five and dime” schedule – 5 hours work followed by 10 hours off – in complete disregard of the human 24 hour biological clock.

What are the implications of sleeping less than 6 hours a day?

1. Poor performance- Chronically sleep deprive people and they can’t think straight. Cognition deteriorates, often worsening over weeks and months.

4. Increased moral hazard – work done by Walter Reed Army Institute of Research showed morally fraught decisions – like what to do in simulated combat scenarios involving civilians – declines rapidly with encroaching sleep loss.

5. Increased irritability, anger and mood shifts. Recent reports of suicide among female personnel define numbers much higher than in civilian life. Sexual aggression, abuse and assault remains a major problem for the U.S. military. Chronic sleep deprivation can only worsen both problems.

6. Post Traumatic Stress – data presented at the panel by Colonel Vince Mysliwiec demonstrated that insufficient sleep was a far bigger associational factor for PTSD than traumatic brain injury – and pretty much any other factor.

7. Long Term Health Care Costs. The sleep patterns developed in the military did not necessarily end when people return to civilian life. Several panel members emphasized that with 2 million active service personnel, the civilian medical sector is unprepared for what will hit it once soldiers come out of the military.

Data from Harvard have shown very high rates of sleep apnea among police. Preliminary reports in the military also show high levels of sleep apnea among active military personnel. Sleep physician Dr. Robert Reyna explained to me that a diagnosis of sleep apnea can immediately trigger a 50% service connection – 50% disability for life through the VA system. Cost benefit analysis of potential sleep apnea disability payments alone should make eyebrows rise throughout Washington.

8. Shift Work – It’s well known that shift work increases cardiovascular risk, GI disturbances and depression. The WHO even wants to label shift work a potential carcinogen. So called “five and dime” type shifts have disappeared from the civilian sector because they are contrary to human biology.

A 24 hour clock resides in every human cell. It’s a basic design element of human beings, indeed of most life on earth. If you work on schedules that continually disregard that 24 hour clock, people feel tired, drugged, dull, and stressed. Even among fit, younger people, health and mental indices deteriorate.

Bottom Line

In combat, life and death is 24/7. Shift work is a necessity for the military.

Yet as Lieutenant Commander Justin Campbell of the Navy carefully described for sailors preparing for the Middle East, the schedules of deployment – with accelerated training before and after departure, haphazard travel schedules added on to jet lag, followed by deployment into tent billets in the middle of the desert, even non-combat work can play havoc with soldiers’ performance. Dr. Shattuck was at pains to point out that the new Chief of Naval Operations has specifically commissioned many recent studies. A new military sleep research group has also started at the University of Pittsburgh, one of the nation’s most established sleep research centers.

American soldiers remain in combat roles in Afghanistan, Iraq and Syria, with “peacekeeping” duties throughout the world. Defense remains a global activity that never ceases. Yet fighting numerous and global asymmetric conflicts is difficult enough without fighting human biology.

The American Association of Sleep Medicine has just put out guidelines recommending “seven hours or more sleep” for adults every night. Hopefully more of the U.S. military will heed this recommendation.